Action Points

Note that this observational study found that patients with psoriatic arthritis had a greater risk of prior cardiovascular disease than controls of similar age.

Be aware that the SCORE algorithm, used to gauge 10-year CVD risk, found similar profiles among those with PsA and controls, suggesting that the algorithm may not be appropriate for the PsA population.

Patients with psoriatic arthritis (PsA) have a higher risk of cardiovascular disease (CVD) than patients without PsA but no difference in 10-year risk for a fatal CV event as assessed by the European Systematic Coronary Risk Evaluation (SCORE), a new population-based study has shown.

However, compared with non-PsA patients, those with this condition have higher CV risks not included in the SCORE algorithm, according to Agnete Malm Gulati, Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway, and colleagues.

"We found a significantly higher prevalence of obesity, smoking and hypertension in addition to higher triglyceride levels in patients with PsA," wrote the authors.

The analysis included Norwegian residents who participated in the third Nord-Trondelag Health Study (HUNT3) from 2006 and 2008. Of the 93,680 eligible adults, 50,807 (54.1%) completed this survey.

HUNT 3 included questions about psoriasis, rheumatoid arthritis (RA), and ankylosing spondylitis (AS). Those with psoriasis completed a more detailed questionnaire including items on whether they had PsA.

In total, 1,238 subjects reported suffering from PsA, RA and psoriasis, or AS and psoriasis. Controls were participants in HUNT 3 without PsA.

The study identified 338 survey respondents with PsA (mean age 54.3 years and mean disease duration 9.2 years), and 50,468 controls (mean age 53.9 years). The sex ratio was the same in both groups.

Researchers calculated the 10-year risk of a fatal CV event using the SCORE algorithm, which includes age, sex, smoking status, systolic blood pressure (BP), and total cholesterol to HCL-c ratio. They categorized subjects into four groups according to risk level: low (<1%), moderate (1%-4%), high (5%-9%) and very high (≥10%).

According to the latest European Society of Cardiology (ESC) guidelines, patients with a history of MI, stroke, CABG, PCI, or diabetes are automatically classified as having a very high risk for CVD and so a SCORE calculation is not necessary.

Of the patients with PsA, 13.4% were allocated to the very high CV risk group due to established CVD or diabetes compared with 11.3% of the control group

The median for CV risk in PsA patients was low and comparable to controls (0.87 versus 0.83; P=0.24). This similar CV risk was present in all the four CV risk classes.

"PsA patients had an overall low risk of a fatal CV event within 10 years estimated by SCORE, and the risk was not different from that in the control subjects," wrote the authors. "Except for smoking, there were no differences between patients with PsA and controls in the presence of risk factors included in the SCORE algorithm."

In addition to being more likely to be daily smokers (21.3% versus 16.4% for controls; P=0.02 after adjusting for age and gender), PsA patients had significantly higher triglyceride levels (1.77 mmol/L versus 1.63 mmol/L; P=0.01) although this finding was not significant after adjusting for body mass index (BMI).

Patients with PsA had significantly higher median CRP than controls (2.1 mg/L versus 1.2 mg/L; P<0.001) and they more often had hypertension (45.3% versus 39.3%; P=0.01). The hypertension prevalence is higher than previously reported, the authors noted

"The difference between patients with PsA and controls was attenuated when adjusting for BMI, which indicates that obesity is a confounder and contributes to increased BP in patients with PsA," they wrote.

"Our data confirm the increased prevalence of obesity in PsA" said the authors. "It is well known that obesity is associated with CVD, thromboembolic disease, diabetes mellitus, and several other comorbidities. Whether obesity is a risk factor for PsA or a consequence of the disease remains a matter of debate."

There was also a higher prevalence of angina pectoris and history of PCI in PsA patients compared with controls. Total CVD was defined as one or more of angina, MI, cerebrovascular stroke, CABG, or PCI, and there was no difference between groups (8.0% in both; P=.20)

As with RA, chronic inflammation may explain the higher risk for developing atherosclerosis in PsA patients, said the authors.

The relatively small number of PsA patients in the study may have reduced the statistical power and introduced false-negative findings. Other potential limitations of the study were that the authors didn't explore the relationship between clinical disease activity of PsA and the occurrence of CV risk factors and disease, and the diagnoses of CVD were self-reported and not validated.

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